Evaluation of an inpatient psychiatric hospital physician education program and adherence to American Diabetes Association practice recommendations.

OBJECTIVE: This study evaluated adherence to American Diabetes Association (ADA) recommendations for diabetes monitoring following an educational intervention for physicians in an inpatient psychiatric hospital. METHODS: This retrospective chart review was conducted in an inpatient psychiatric institution from July 1, 2010-January 15, 2011. A total of 120 subjects (60 subjects each in the pre- and post-intervention groups) meeting the inclusion criteria served as the study sample. Included subjects were admitted and discharged from an inpatient psychiatric institution within 90 days prior to (pre-intervention) and following (post-intervention) the physician education program. The medical staff was presented an educational program intervention, consisting of a 30 minute overview of the ADA 2010 Standards of Care recommendations and distribution of laminated treatment reminders. Electronic grouped order sets for patients with diabetes were also created and implemented. RESULTS: The primary outcome was change (pre-intervention to post-intervention) in frequency of hemoglobin A1c documentation on admission following the intervention. Secondary outcomes included the change in frequency of documentation of fasting plasma glucose, serum creatinine, urine creatinine/microalbumin ratio (UMA), fasting lipid profile (FLP), and change in days on sliding scale insulin. Regarding change in frequency of documentation of A1c values on admission, chi-square analysis revealed a significant increase from pre-intervention to post-intervention period of 30% (n = 18) to 61.7% (n = 37), respectively (p = 0.0005). Documentation of FLP also significantly increased [73.3% vs. 91.7% (p = 0.0082)]. There were no significant differences in the documentation of fasting plasma glucose, serum creatinine, and UMA or days treated with sliding scale insulin. CONCLUSION: The physician education program was successful in increasing the assessment of A1c values and lipid profiles for patients with diabetes mellitus in a psychiatric institution.

Postdischarge interventions by pharmacists and impact on hospital readmission rates.

OBJECTIVES: To determine whether a difference exists in hospital readmission rates at 60 days postdischarge between patients who saw (intervention group) or did not see (control group) a pharmacist within 60 days of discharge and to describe the number and type of pharmacist interventions. DESIGN: Retrospective electronic record review. SETTING: Austin, TX, from January 2006 to January 2010. PATIENTS: 131 adult patients aged 18 to 65 years who were on at least three prescription medications. INTERVENTION: Pharmacist visit within 60 days post-hospital discharge. MAIN OUTCOME MEASURE: Hospital readmission rates at 60 days postdischarge. RESULTS: The intervention and control groups did not differ regarding age or gender, but the control group had a higher percentage of whites, fewer medications, and fewer diseases. Chi-square analyses revealed that of 65 patients in the control group, 28 (43.1%) were readmitted to the hospital within 60 days of discharge compared with 12 of 66 (18.2%) intervention group patients (P = 0.0020). Pharmacists provided approximately two interventions per patient. The most frequently provided pharmacist interventions were medication counseling (88.1%) and drug dosage adjustment (52.2%). CONCLUSION: Patients on multiple prescription medications and with chronic diseases may benefit from a pharmacist visit within 60 days of hospital discharge. However, future studies are needed to further determine the effectiveness of pharmacists' interventions post-hospital discharge.